In this case, Dr. Tobias Carling and Dr. Courtney Gibson at Smilow Cancer Hospital at Yale New Haven perform a TOETVA on a 45-year-old patient who presented with a growing thyroid nodule that was shown to be a Hurthle cell neoplasm on fine-needle aspiration.
Numerous minimally-invasive approaches to thyroidectomy have been developed over the years to minimize the neck surgical scar, many of which are performed using endoscopic or robotic assistance. However, a more diminutive anterior cervical scar still remains a problem for some patients, as well as more extensive dissections for remote access operations. Therefore, natural orifice surgery was adopted at select institutions in an effort to perform a truly scarless thyroidectomy. Trans-oral endoscopic thyroidectomy has been the latest approach developed, known as the natural orifice transluminal endoscopic thyroidectomy, which is categorized as a natural orifice transluminal endoscopic surgery (NOTES) procedure. There are several ways to perform the natural orifice transluminal endoscopic thyroidectomy. Here, the authors present the TOETVA under general anesthesia.
Tobias Carling, MD, PhD, FACS Yale School of Medicine
Cortical-sparing adrenalectomy allows for the resection of adrenal tumors while preserving unaffected adrenal tissue to prevent adrenal insufficiency. This is especially important in patients with bilateral adrenal tumors, typically pheochromocytomas.
Posterior retroperitoneoscopic adrenalectomy (PRA) allows for a minimally invasive approach to adrenal gland resection compared with the more traditional laparoscopic transabdominal adrenalectomy and open approaches. This approach is ideal to address patients with bilateral disease and was used in this case of a 31-year-old female patient presenting with bilateral pheochromocytomas in the setting of multiple endocrine neoplasia 2A syndrome and coexisting medullary thyroid carcinoma of the right thyroid lobe. A close review of her imaging demonstrated normal-appearing adrenal cortex tissue on the right side that allowed for cortical-sparing adrenalectomy on that side.
Richard Hodin, MD
Professor of Surgery
Harvard Medical School
In this case, a 58-year-old female was found to have hyperaldosteronism, and a CT scan revealed bilateral cortical adenomas. Here, Dr. Richard Hodin, MD, walks the viewer through the analysis of adrenal vein sampling and performs a right laparoscopic adrenalectomy at MGH.